18 August 2020
Hemangioma, Therapeutics, Network meta-analysis, IH, infantile hemangioma, PRO, propranolol, PDL, pulsed dye laser, LPDL, PDL at a long pulse duration, Nd, Nd:YAG laser, Laser, PDL and Nd:YAG laser, β, topical β-blockers treatment, ATL, atenolol, PED, prednisone, IMQ, imiquimod, TA, triamcinolone, CAP, captopril, OR, odds ratios, CI, confidence intervals, RCT, randomized clinical trials, NMA, network meta-analysis, SUCRA, surface under the cumulative ranking curve, H, a higher dose, L, a longer treatment duration, S, a shorter treatment duration
Infantile hemangioma (IH) is common in children, which may bring about cosmetically disfiguring, functional impairment, and exhibiting complications. There had been various therapies and we aimed to assess the efficacy and adverse effects of different therapies through network meta-analysis.
We searched PubMed, Embase, Cochrane Library and Web of Science (from database inception to April 11, 2020) for studies assessing the efficacy, success rate and adverse effects. Direct pairwise comparison and a network meta-analysis under random effects were performed. We also assessed the ranking probability.
A total of 30 randomized clinical trials with more than 20 different therapeutic regimens were identified. Treatment combined propranolol orally with laser could improve the curative effect than monotherapy. Laser with topical β blockers showed more efficiency than others whether in children under 6 months or not. The long-pulsed dye laser might be the best laser therapy. A higher dose and a longer treatment duration of propranolol orally achieved a higher success rate and increased side effects. Plus pulse dye laser with propranolol had the lowest incidence of adverse reactions, such as ulcer, color sink and color reduction.
A combination of β blockers and laser might be the first-line treatment of IHs and a longer pulsed dye laser is preferred.